LAST year ended on a posit-ive note for Cambodia. The country is moving closer to the nation-wide elimination of measles: the national immunisat-ion program reported no cases during the 12 months to December.
This represents a dramatic reduction from 2011, when more than 700 cases of measles in children were reported, and from 2008, when there were more than 1,800 cases.
The last laboratory-confirmed case of measles was reported from Kampong Speu province in November, 2011.
This news is indeed encouraging. By all accounts, it indicates that Cambodia is on the path to becoming a measles-free country, together with every other country in the western Pacific region.
In 2003, the World Health Organis-ation’s regional office for the western Pacific set 2012 as the target date for measles elimination, defined as the absence of transmission of endemic measles virus.
Measles is one of the most infect-ious viruses known to humans. It can cause serious illness and complications, particularly in infants and children, including pneumonia and blindness.
Cambodia’s gains towards achieving measles elimination are the result of intensified nationwide vaccination efforts to ensure the termination of wild-virus circulat-ion, and improved disease-surveillance systems.
As with other countries that have declared the elimination of measles, Cambodia’s national elimination plan includes a high, two-dose immunisation coverage and a surveillance system capable of a rapid response to potential outbreaks.
Cambodia’s measles-control efforts began in 1986 with the introduction of a single dose of measles vaccine for all infants at the age of nine months.
Progressively higher coverage with the single dose was accelerated with nationwide immunis-ation campaigns in 2001–03, 2007 and 2011.
These campaigns received support from the royal government’s contributions, Cambodia’s health partners, led by the World Health Organisation, UNICEF, AusAID, JICA and Latter-day Saint Charities, and the Second Health Sector Support Project pool-fund partners.
A year ago, the program introduced a second dose of measles vaccine for all children at the age of 18 months to further ensure the highest level of protection.
All children under the age of two will now receive two doses of measles vaccine: the first at nine months, the second at 18 months.
Countries providing two opportunities for measles vaccination have experienced a dramatic decline in cases and an even greater reduction in the number of deaths.
The close involvement of Cambodia’s health partners, civil society, community leaders, health-centre staff and village health volunteers, under the leadership of the Ministry of Health, was vital to the success of the immunisation campaigns.
This multi-sectoral, multi-partner involvement is important in ident-ifying and vaccinating infants and children in high-risk communities who often miss their routine dose of measles vaccine.
The effective integration of the expanded immunisation program with the health system has also ensured that all infants and children in these communities receive full vaccination.
Overall, Cambodia’s measles elimination efforts have benefited from the experience gained in the 1990s, when the country got rid of polio.
Cambodia’s polio-eradication measures included both national immunisation days and a house-to-house vaccination campaign.
These efforts paid off, and the last case of wild polio virus in Cambodia was in March 1997. It was also the last case in the western Pacific.
Good planning at the grassroots level, the commitment of health workers, efficient vaccine delivery, effective social mobilisation, public support and strong political backing provide a solid platform for the Ministry of Health to introduce additional vaccines, such as the rubella vaccine this year.
Rubella can cause congenital rubella syndrome (CRS) in new- borns. CRS is the main reason a vaccine for rubella was developed.
Many mothers who contract rubella within the critical first trimester suffer a miscarriage or a still-born baby.
If the baby survives the infection, it can be born blind, deaf, with severe heart disorders, or with other life-threatening defects.
Building on Cambodia’s polio eradication and measles elimin-ation efforts, the beginning of a rubella mass immunisation campaign in the latter part of this year will be a pragmatic approach to controlling rubella and eliminating CRS in the shortest possible time.
It’s a tremendous achievement to be able to say Cambodia is free from measles. The challenge now is to maintain its achievement of having no measles cases for another two years, so the country can be certified by the World Health Organis-ation as having eliminated measles.
This will require a strong focus on routine immunisation and ensuring the vaccination campaign reaches the Kingdom’s most marginalised communities — the urban and rural poor, along with ethnic and minor-ity groups — with two doses of measles vaccine before every child’s second birthday.
High levels of vaccination coverage will still be needed in order to prevent re-introduction of the virus from other areas, and vaccination can be ceased only when measles is eradicated by the interruption of measles transmission globally.
Clearly, Cambodia is on the right track, and the World Health Organ-isation is confident it will be certified measles-free by 2014.